1.A 10 yo M is admitted to the ED with a temperature of 104 and respiratory difficulty. Physical
exam is notable for wheezing in all lung fields bilaterally and increased tactile fremitus. he has 4-
6 of these severe infections every year. Past records obtained from an outside hospital reveal
repeated S.Aureus, E. Coli, and A. Fumigatus infections. These organisms possess an enzyme
that breaks down harmful reactive species. Further testing of this patient's blood sample would
most likely reveal? CGD defective NADPH oxidase… x-linked rec. inheritance(only shows up
in boys) tx: IFN-GAMMA… NEUTROPHIL ARE AFFECTED IN CGD
a. A deficiency of chemotactic factors for neutrophils
b. A deficiency of CD18
c. A deficiency of myeloperoxidase
d. A deficiency of an NADPH requiring enzyme
e. Marked eosinophilia
2.2 months into your rotation, a lady brings her 2 week old child to the office for his
recommended vaccinations. The mom, who has been on HAART for the past 10 years is worried
that her child may have contracted the offending organism transplacentally or during delivery.
Serum studies are conducted to allay the patient’s fears. The presence of which of the following
is most consistent with ruling in vertical transmission?
a. Anti p24 surface IgG
b. Anti p24 surface IgA
c. Anti p24 surface IgM
d. Anti p24 surface IgE
e. Anti p24 surface IgD
3.A 3 year old infant presents with severe GI distress and sinusitis. His mother reports that he has
had these symptoms on a recurrent basis about 6 months after he was born. Serum protein
electrophoresis conducted on a sample obtained from the infant showed a predominance of a
structure with heavy chains and light chains joined together in a pentameric arrangement. The
infant’s condition is most likely due to which of the following pathologic processes?Hyper IgM
syndrome problem w CD40 and CD40ligand ..tx: IVIG
a. Failure of T cell maturation.
b. Failure of a ligand interaction between CD4+ cells and CD19+ cells.
c. Failure of a ligand interaction between CD8+ cells and CD19+ cells.
d. Failure of B cell maturation.
, e. A defect in a cellular adhesion molecule found on B cells.
4.A 7 month old infant has the sudden onset of severe abdominal pain and cramping
accompanied by chest pain, nonproductive cough, and fever. On PE, his temperature is 39
degrees, pulse is 130/min, RR is 25/min, and blood pressure is 90/60 mmHg. He has diffuse
abdominal tenderness but no masses or organomegaly. Lab studies show a Hematocrit of 20%.
The peripheral blood smear is shown in the figure below. Assuming the infant in question had
this problem at birth, the most likely explanation for the delay in his current symptoms
is?SICKLE CELL DZ … less hgb F
a. The protective effect of IgG antibodies transmitted from the mom to the infant in utero.
b. The protective effect of a tetrameric hemoglobin molecule that is typically increased in
Beta thalassemia minor.
c. The protective effect of a tetrameric hemoglobin molecule that has a high affinity for
oxygen compared to Hemoglobin A in utero.
d. High titers of “specific immunoglobulins” originating from stem cells in the peritubular
capillaries of the kidney.
e. High titers of a growth factor that encourages erythropoiesis.
5.A woman presents to the free clinic with signs and symptoms of leg pain and swelling that
arose over the last 3 days. Her D-dimer levels are elevated which raises your suspicion of a
DVT. In the process of conducting other blood studies, you notice an elevated beta HCG level
and Ultrasound reveals a 4 week old fetus. What is the mechanism of action of the drug that best
decreases the risk of adverse events as a consequence of the DVT? Low mol. Wgt heparin
a. Increases the activity of Antithrombin 3.
b. Binds to an ADP receptor and prevents platelet activation. Clopidrogrel adp recep.
blocker
c. Inhibits the activation of Factors 2, 7, 9, 10, Protein C, and Protein S. warfarin
d. Increases the release of VWF from endothelial cells. ddavp
e. Irreversibly inhibits cyclooxygenase and prevents the formation of Thromboxane A2.
Asa
,6.A 35 yo smoker is admitted to the hospital with signs and symptoms of acute chest pain with
radiation to the jaw. Serial ECGs indicate the presence of an ongoing myocardial infarction.
Thrombolytic therapy is rapidly initiated with prompt resolution of the patient’s symptoms. 4
hours later, the patient begins to have seizures with subsequent bleeding from his ears. Reversal
of these acute symptoms can best be established by the administration of a drug that;
aminocaproic acid to reverse Tpa toxicity…
a. Activates plasminogen.
b. Degrades fibrin.
c. Activates fibrinogen.
d. Inhibits plasminogen conversion to plasmin.
e. Inhibits fibrinogen conversion to fibrin.
7.A 44yo man who recently underwent a Coronary Angioplasty receives a 6 month prescription
for an injectable monoclonal antibody that interferes with platelet aggregation. The mechanism
of action of this drug produces physiological effects that are most similar to a patient with?
Abciximab inh- gp2b3a.. similar to :
a. Bernard Soulier Disease gp1b
b. Von Willebrand Disease vwf
c. Hemophilia A 8
d. Hemophilia B 9
e. Glanzmann Thrombasthenia
8.A 19 yo. medical student is enrolled in a clinical trial for a new thrombolytic agent. While
signing a disclosure form, he mentions having a genetic disorder that leads to a decreased
inactivation of Factor 10 and Thrombin. To confirm this disclosure, experimental assays are
conducted with samples drawn from his serum. The most plausible result of this experiment is;
antithrombin 3 deficiency…. (At3 inh- factors 2 and 10).. so no effect of heparin due to no at3
a. No change in PTT upon administration of Warfarin.
b. An increase in INR upon administration of Warfarin.
c. A decrease in PTT upon administration of Heparin.
d. No change in PT upon administration of Heparin.
e. An increase in bleeding time upon administration of Warfarin.
f. No change in PTT upon administration of Heparin.
, g. An increase in PT, PTT, and Bleeding Time.
9.A 27 yo. pregnant woman from West Africa presents to the ER with an acute complaint of
blood in her stool. PE reveals petechiae on her skin and buccal mucosa, HR is 35 bpm, BP is
90/50. The patient suddenly begins to cough up blood. A CBC reveals anemia and
thrombocytopenia. She is bleeding from every possible IV site as vascular access is established.
The patient takes a Folate supplement daily. Choose the set of values that best agree with this
patient’s presentation. DIC.. answer is letter E.
10.A healthy 17 yo. female suffered blunt abdominal trauma in a MVA. Her CBC on admission
showed a Hct of 33% which decreased to 25% over the next hour. In the process of treatment
and supportive care, 1L of bloody fluid was evacuated from the patient’s abdomen with marked
improvement of her symptoms. A CBC performed 3 days later is most likely to reveal which of
the following RBC morphologies. She has hemolytic anemia and is loosing much blood, the
body makes more!
a. Basophilic Stippling
b. Hypochromic RBCs
c. Leukocytosis
d. Reticulocytosis
e. Schistocytosis
f. Spherocytosis
11.A 4 yo. boy from Palermo has a poor appetite and is underweight for his age. PE reveals
hepatosplenomegaly. Blood studies reveal a Hb of 6 g/dL, MCV of 60 fL, normal levels of
serum Fe, a reticulocyte count of 12%, and RBCs with widened central pallor(they are target
cells). Skull radiographs reveal facial deformities and expansion of marrow spaces. The most
likely cause of this child’s illness is; thalassemia
a. An imbalance in alpha and beta globin gene production.
b. Increased fragility of RBC membranes.
c. Increased synthesis of HbF.
exam is notable for wheezing in all lung fields bilaterally and increased tactile fremitus. he has 4-
6 of these severe infections every year. Past records obtained from an outside hospital reveal
repeated S.Aureus, E. Coli, and A. Fumigatus infections. These organisms possess an enzyme
that breaks down harmful reactive species. Further testing of this patient's blood sample would
most likely reveal? CGD defective NADPH oxidase… x-linked rec. inheritance(only shows up
in boys) tx: IFN-GAMMA… NEUTROPHIL ARE AFFECTED IN CGD
a. A deficiency of chemotactic factors for neutrophils
b. A deficiency of CD18
c. A deficiency of myeloperoxidase
d. A deficiency of an NADPH requiring enzyme
e. Marked eosinophilia
2.2 months into your rotation, a lady brings her 2 week old child to the office for his
recommended vaccinations. The mom, who has been on HAART for the past 10 years is worried
that her child may have contracted the offending organism transplacentally or during delivery.
Serum studies are conducted to allay the patient’s fears. The presence of which of the following
is most consistent with ruling in vertical transmission?
a. Anti p24 surface IgG
b. Anti p24 surface IgA
c. Anti p24 surface IgM
d. Anti p24 surface IgE
e. Anti p24 surface IgD
3.A 3 year old infant presents with severe GI distress and sinusitis. His mother reports that he has
had these symptoms on a recurrent basis about 6 months after he was born. Serum protein
electrophoresis conducted on a sample obtained from the infant showed a predominance of a
structure with heavy chains and light chains joined together in a pentameric arrangement. The
infant’s condition is most likely due to which of the following pathologic processes?Hyper IgM
syndrome problem w CD40 and CD40ligand ..tx: IVIG
a. Failure of T cell maturation.
b. Failure of a ligand interaction between CD4+ cells and CD19+ cells.
c. Failure of a ligand interaction between CD8+ cells and CD19+ cells.
d. Failure of B cell maturation.
, e. A defect in a cellular adhesion molecule found on B cells.
4.A 7 month old infant has the sudden onset of severe abdominal pain and cramping
accompanied by chest pain, nonproductive cough, and fever. On PE, his temperature is 39
degrees, pulse is 130/min, RR is 25/min, and blood pressure is 90/60 mmHg. He has diffuse
abdominal tenderness but no masses or organomegaly. Lab studies show a Hematocrit of 20%.
The peripheral blood smear is shown in the figure below. Assuming the infant in question had
this problem at birth, the most likely explanation for the delay in his current symptoms
is?SICKLE CELL DZ … less hgb F
a. The protective effect of IgG antibodies transmitted from the mom to the infant in utero.
b. The protective effect of a tetrameric hemoglobin molecule that is typically increased in
Beta thalassemia minor.
c. The protective effect of a tetrameric hemoglobin molecule that has a high affinity for
oxygen compared to Hemoglobin A in utero.
d. High titers of “specific immunoglobulins” originating from stem cells in the peritubular
capillaries of the kidney.
e. High titers of a growth factor that encourages erythropoiesis.
5.A woman presents to the free clinic with signs and symptoms of leg pain and swelling that
arose over the last 3 days. Her D-dimer levels are elevated which raises your suspicion of a
DVT. In the process of conducting other blood studies, you notice an elevated beta HCG level
and Ultrasound reveals a 4 week old fetus. What is the mechanism of action of the drug that best
decreases the risk of adverse events as a consequence of the DVT? Low mol. Wgt heparin
a. Increases the activity of Antithrombin 3.
b. Binds to an ADP receptor and prevents platelet activation. Clopidrogrel adp recep.
blocker
c. Inhibits the activation of Factors 2, 7, 9, 10, Protein C, and Protein S. warfarin
d. Increases the release of VWF from endothelial cells. ddavp
e. Irreversibly inhibits cyclooxygenase and prevents the formation of Thromboxane A2.
Asa
,6.A 35 yo smoker is admitted to the hospital with signs and symptoms of acute chest pain with
radiation to the jaw. Serial ECGs indicate the presence of an ongoing myocardial infarction.
Thrombolytic therapy is rapidly initiated with prompt resolution of the patient’s symptoms. 4
hours later, the patient begins to have seizures with subsequent bleeding from his ears. Reversal
of these acute symptoms can best be established by the administration of a drug that;
aminocaproic acid to reverse Tpa toxicity…
a. Activates plasminogen.
b. Degrades fibrin.
c. Activates fibrinogen.
d. Inhibits plasminogen conversion to plasmin.
e. Inhibits fibrinogen conversion to fibrin.
7.A 44yo man who recently underwent a Coronary Angioplasty receives a 6 month prescription
for an injectable monoclonal antibody that interferes with platelet aggregation. The mechanism
of action of this drug produces physiological effects that are most similar to a patient with?
Abciximab inh- gp2b3a.. similar to :
a. Bernard Soulier Disease gp1b
b. Von Willebrand Disease vwf
c. Hemophilia A 8
d. Hemophilia B 9
e. Glanzmann Thrombasthenia
8.A 19 yo. medical student is enrolled in a clinical trial for a new thrombolytic agent. While
signing a disclosure form, he mentions having a genetic disorder that leads to a decreased
inactivation of Factor 10 and Thrombin. To confirm this disclosure, experimental assays are
conducted with samples drawn from his serum. The most plausible result of this experiment is;
antithrombin 3 deficiency…. (At3 inh- factors 2 and 10).. so no effect of heparin due to no at3
a. No change in PTT upon administration of Warfarin.
b. An increase in INR upon administration of Warfarin.
c. A decrease in PTT upon administration of Heparin.
d. No change in PT upon administration of Heparin.
e. An increase in bleeding time upon administration of Warfarin.
f. No change in PTT upon administration of Heparin.
, g. An increase in PT, PTT, and Bleeding Time.
9.A 27 yo. pregnant woman from West Africa presents to the ER with an acute complaint of
blood in her stool. PE reveals petechiae on her skin and buccal mucosa, HR is 35 bpm, BP is
90/50. The patient suddenly begins to cough up blood. A CBC reveals anemia and
thrombocytopenia. She is bleeding from every possible IV site as vascular access is established.
The patient takes a Folate supplement daily. Choose the set of values that best agree with this
patient’s presentation. DIC.. answer is letter E.
10.A healthy 17 yo. female suffered blunt abdominal trauma in a MVA. Her CBC on admission
showed a Hct of 33% which decreased to 25% over the next hour. In the process of treatment
and supportive care, 1L of bloody fluid was evacuated from the patient’s abdomen with marked
improvement of her symptoms. A CBC performed 3 days later is most likely to reveal which of
the following RBC morphologies. She has hemolytic anemia and is loosing much blood, the
body makes more!
a. Basophilic Stippling
b. Hypochromic RBCs
c. Leukocytosis
d. Reticulocytosis
e. Schistocytosis
f. Spherocytosis
11.A 4 yo. boy from Palermo has a poor appetite and is underweight for his age. PE reveals
hepatosplenomegaly. Blood studies reveal a Hb of 6 g/dL, MCV of 60 fL, normal levels of
serum Fe, a reticulocyte count of 12%, and RBCs with widened central pallor(they are target
cells). Skull radiographs reveal facial deformities and expansion of marrow spaces. The most
likely cause of this child’s illness is; thalassemia
a. An imbalance in alpha and beta globin gene production.
b. Increased fragility of RBC membranes.
c. Increased synthesis of HbF.
